Bernatsky Sasha, Ramsey-Goldman Rosalind, Boivin Jean-François, Joseph Lawrence, Moore Andrew D, Rajan Raghu, Clarke Ann
Division of Clinical Epidemiology, Department of Oncology, Montreal General Hospital, Montreal, Quebec, Canada.
J Rheumatol. 2003 Jul;30(7):1505-7.
To determine to what extent the observed experience of breast cancer in a combined cohort of patients with systemic lupus erythematosus (SLE) could be explained by the profile of breast cancer risk factors.
Data were pooled from 2 centers, the Montreal General Hospital and the Feinberg School of Medicine at Northwestern University in Chicago. For each female cohort member, the probability of developing breast cancer during followup was estimated based on factors (including the individual's age, parity, age at first live birth, age of menarche, personal history of benign breast disease, and family history) using the Gail model, an established model for predicting breast cancer risk. The actual occurrence of cancer cases was determined by linkage with regional cancer registries.
Of the 583 women in the combined cohort, 5 had been diagnosed with breast cancer prior to cohort entry, and 14 declined participation. In those remaining, 12 cases of breast cancer occurred compared to 5.6 predicted by the Gail model (standardized incidence ratio 2.1, 95% confidence interval: 1.1, 3.7). Thus, after controlling for risk factors, the incidence of breast cancer was elevated.
Our data suggest that the risk of breast cancer in our SLE cohort is not completely explained by traditional factors found in the Gail model. Other factors, such as carcinogenic exposures (i.e., alkylating agents and immunosuppressive drugs) or the immunologic dysregulation of SLE itself, may be contributory.
确定系统性红斑狼疮（SLE）患者联合队列中观察到的乳腺癌经历在多大程度上可由乳腺癌风险因素概况来解释。
数据来自两个中心，蒙特利尔综合医院和芝加哥西北大学费恩伯格医学院。对于每个女性队列成员，使用盖尔模型（一种既定的预测乳腺癌风险的模型），根据因素（包括个体年龄、生育情况、首次生育年龄、初潮年龄、乳腺良性疾病个人史和家族史）估计随访期间患乳腺癌的概率。癌症病例的实际发生情况通过与区域癌症登记处的关联来确定。
在联合队列的583名女性中，5人在队列入组前被诊断患有乳腺癌，14人拒绝参与。在其余人员中，发生了12例乳腺癌，而盖尔模型预测为5.6例（标准化发病率比为2.1，95%置信区间：1.1，3.7）。因此，在控制风险因素后，乳腺癌发病率有所升高。
我们的数据表明，我们的SLE队列中乳腺癌风险不能完全由盖尔模型中的传统因素来解释。其他因素，如致癌暴露（即烷化剂和免疫抑制药物）或SLE本身的免疫失调，可能起了作用。
